肝移植后多重耐药菌感染的相关危险因素
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摘要
背景:肝移植后多重耐药菌感染严重影响肝移植后患者的存活率和死亡率,多重耐药菌感染治疗的高失败率也引起了关注。目的:分析肝移植后多重耐药菌感染的危险因素。方法:采用队列研究对114例肝移植患者的临床资料进行收集和分析,多重耐药菌感染组共28例;非多重耐药菌感染组共86例。统计多重耐药菌感染率,进行单因素分析及多元Logistic回归分析确定独立危险因素。结果与结论:(1)肝移植后多重耐药菌的感染率为24.6%;(2)多元Logistic回归分析结果显示,4个因素是影响肝移植后多重耐药菌感染的独立危险因素:凝血酶原时间延长(OR:3.102,95%CI0.066-9.024,P=0.038)、ICU留置时间≥10 d(OR:3.745,95%CI 1.313-10.687,P=0.014)、气管插管时间≥72 h(OR:8.972,95%CI 1.983-40.582,P=0.004)、胸腔穿刺(OR:3.564,95%CI 1.223-10.387,P=0.020);(3)结果显示,凝血酶原时间延长、ICU留置时间≥10 d、气管插管时间≥72 h和胸腔穿刺会增加肝移植后患者发生多重耐药菌感染的风险。
BACKGROUND: Multi-drug resistant organisms(MDRO) infection after liver transplantation seriously affects the survival and mortality of patients after liver transplantation. High failure in MDRO infection treatment catches much attention. OBJECTIVE: To analyze the risk factors for MDRO infection after liver transplantation.METHODS: A prospective cohort study was used to collect and analyze the clinical data of 114 patients after liver transplantation. There were 28 cases of MDRO infection, and 86 cases of non-MDRO infection. The MDRO infection rate was calculated. Univariate analysis and multivariate logistic regression analysis were used to screen independent risk factors. RESULTS AND CONCLUSION: The MDRO infection rate after liver transplantation was 24.6%. Multivariate logistic regression analysis results showed the following four factors: prolonged prothrombin time(OR: 3.102, 95% CI(0.066-9.024), P=0.038), ICU retention time ≥ 10 days(OR: 3.745, 95%CI(1.313-10.687), P=0.014), tracheal intubation time ≥ 72 hours(OR: 8.972, 95%CI(1.983-40.582), P=0.004), thoracentesis(OR: 3.564, 95%CI(1.223-10.387), P=0.020). These results imply that prolonged prothrombin time, ICU indwelling time ≥ 10 days, tracheal intubation time ≥ 72 hours and thoracentesis can increase the risk of MDRO infection in patients after liver transplantation.
BACKGROUND: Multi-drug resistant organisms(MDRO) infection after liver transplantation seriously affects the survival and mortality of patients after liver transplantation. High failure in MDRO infection treatment catches much attention. OBJECTIVE: To analyze the risk factors for MDRO infection after liver transplantation.METHODS: A prospective cohort study was used to collect and analyze the clinical data of 114 patients after liver transplantation. There were 28 cases of MDRO infection, and 86 cases of non-MDRO infection. The MDRO infection rate was calculated. Univariate analysis and multivariate logistic regression analysis were used to screen independent risk factors. RESULTS AND CONCLUSION: The MDRO infection rate after liver transplantation was 24.6%. Multivariate logistic regression analysis results showed the following four factors: prolonged prothrombin time(OR: 3.102, 95% CI(0.066-9.024), P=0.038), ICU retention time ≥ 10 days(OR: 3.745, 95%CI(1.313-10.687), P=0.014), tracheal intubation time ≥ 72 hours(OR: 8.972, 95%CI(1.983-40.582), P=0.004), thoracentesis(OR: 3.564, 95%CI(1.223-10.387), P=0.020). These results imply that prolonged prothrombin time, ICU indwelling time ≥ 10 days, tracheal intubation time ≥ 72 hours and thoracentesis can increase the risk of MDRO infection in patients after liver transplantation.
引文
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[18]谢秀华,孔心涓,饶伟.肝移植术后感染并发症的研究现状及进展[J].实用器官移植电子杂志,2017,5(1):61-64.
[19]Netsvyetayeva I,Sikora M,Golas M,et al.Acinetobacter baumannii multidrug-resistant strain occurrence in liver recipients with reference to other high-risk groups.Transplant Proc.2011;43(8):3116-3120.
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[21]Reddy P,Zembower TR,Ison MG,et al.Carbapenem-resistant Acinetobacter baumannii infections after organ transplantation.Transpl Infect Dis.2010;12(1):87-93.
[22]Sun HY,Cacciarelli TV,Singh N.Impact of pretransplant infections on clinical outcomes of liver transplant recipients.Liver Transpl.2010;16(2):222-228.
[23]Bellier C,Bert F,Durand F,et al.Risk factors for Enterobacteriaceae bacteremia after liver transplantation.Transpl Int.2008;21(8):755-763.
[24]Siniscalchi A,Aurini L,Benini B,et al.Ventilator associated pneumonia following liver transplantation:Etiology,risk factors and outcome.World J Transplant.2016;6(2):389-395.
[25]Lim S,Kim E J,Lee T B,et al.Predictors of postoperative infectious complications in liver transplant recipients:experience of 185 consecutive cases.Korean J Intern Med.2018 Feb 23.
[26]杨富,方芳,陈兰,等.肝移植术后多重耐药菌感染风险预测评分模型的建立与评价[J].护理研究,2017,31(17):2076-2080.
[27]Desai D,Desai N,Nightingale P,et al.Carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of infection after liver transplantation.Liver Transpl.2003,9(7):754-759.
[28]Hashimoto M,Sugawara Y,Tamura S,et al.Methicillin-resistant Staphylococcus aureus infection after living-donor liver transplantation in adults.Transpl Infect Dis.2008;10(2):110-116.
[29]Avkan-Oguz V,Ozkardesler S,Unek T,et al.Risk factors for early bacterial infections in liver transplantation.Transplant Proc.2013;45(3):993-997.
[30]谢秀华,姜英俊,解曼,等.肝移植后早期受者发生感染的危险因素及病原学分析[J].中华器官移植杂志,2017,38(4):200-205.
[31]Shi SH,Kong HS,Jia CK,et al.Risk factors for pneumonia caused by multidrug-resistant Gram-negative bacilli among liver recipients.Clin Transplant.2010;24(6):758-765.
[32]浦燕萍,顾燕,杨富,等.肝移植患者术后多重耐药鲍曼不动杆菌感染影响因素[J].中华肝脏外科手术学电子杂志,2016,5(3):158-162.
[33]Zhong L,Men TY,Li H,et al.Multidrug-resistant gram-negative bacterial infections after liver transplantation-spectrum and risk factors.J Infect.2012;64(3):299-310.
[34]Alonso JC.Pleural effusion in liver disease.Semin Respir Crit Care Med.2010;31(6):698-705.
[35]聂深钰,时宇,高普均.难治性肝性胸水的治疗[J].中国老年学杂志,2015,35(11):3171-3173.
[36]Machicao VI,Balakrishnan M,Fallon MB.Pulmonary complications in chronic liver disease.Hepatology.2014;59(4):1627-1637.
[37]Singh A,Bajwa A,Shujaat A.Evidence-based review of the management of hepatic hydrothorax.Respiration.2013;86(2):155-173.
[38]杨富.肝移植术后多重耐药菌感染风险预测模型的构建[D].上海:上海交通大学,2015.
[2]黄勋,邓子德,倪语星,等.多重耐药菌医院感染预防与控制中国专家共识[J].中国感染控制杂志,2015,14(1):1-9.
[3]中华人民共和国卫生部.多重耐药菌医院感染预防与控制技术指南(试行)[J].中国危重病急救医学,2011,23(2):65.
[4]Shukla A,Vadeyar H,Rela M,et al.Liver Transplantation:East versus West.J Clin Exp Hepatol.2013,3(3):243-253.
[5]Wang FS,Fan JG,Zhang Z,et al.The global burden of liver disease:the major impact of China.Hepatology.2014;60(6):2099-2108.
[6]Li C,Wen TF,Mi K,et al.Analysis of infections in the first 3-month after living donor liver transplantation.World J Gastroenterol.2012;18(16):1975-1980.
[7]Linares L,Garcia-Goez JF,Cervera C,et al.Early bacteremia after solid organ transplantation.Transplant Proc.2009;41(6):2262-2264.
[8]Kim SI.Bacterial infection after liver transplantation.World JGastroenterol.2014;20(20):6211-6220.
[9]Santoro-Lopes G,de Gouvea EF.Multidrug-resistant bacterial infections after liver transplantation:an ever-growing challenge.World J Gastroenterol.2014,20(20):6201-6210.
[10]李明霞,彭贵主,王忍,等.肝移植术后感染研究进展[J].中华肝胆外科杂志,2015,21(7):494-497.
[11]杨富,陈兰,方芳,等.肝移植术后多重耐药菌感染危险因素的系统评价[J].上海交通大学学报(医学版),2015,35(7):1015-1022.
[12][Magiorakos AP,Srinivasan A,Carey RB,et al.Multidrug-resistant,extensively drug-resistant and pandrug-resistant bacteria:an international expert proposal for interim standard definitions for acquired resistance.Clin Microbiol Infect.2012;18(3):268-281.
[13]Shields RK,Clancy CJ,Gillis LM,et al.Epidemiology,clinical characteristics and outcomes of extensively drug-resistant Acinetobacter baumannii infections among solid organ transplant recipients.PLoS One.2012;7(12):e52349.
[14]中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2001,81(5):314-320.
[15]陈佰义,何礼贤,胡必杰,等.中国鲍曼不动杆菌感染诊治与防控专家共识[J].中国医药科学,2012,2(8):3-8.
[16]Kim SI,Kim YJ,Jun YH,et al.Epidemiology and risk factors for bacteremia in 144 consecutive living-donor liver transplant recipients.Yonsei Med J.2009;50(1):112-121.
[17]Friedrich-Rust M,Wanger B,Heupel F,et al.Influence of antibioticregimens on intensive-care unit-mortality and liver-cirrhosis as risk factor.World J Gastroenterol.2016;22(16):4201-4210.
[18]谢秀华,孔心涓,饶伟.肝移植术后感染并发症的研究现状及进展[J].实用器官移植电子杂志,2017,5(1):61-64.
[19]Netsvyetayeva I,Sikora M,Golas M,et al.Acinetobacter baumannii multidrug-resistant strain occurrence in liver recipients with reference to other high-risk groups.Transplant Proc.2011;43(8):3116-3120.
[20]Hand J,Patel G.Multidrug-resistant organisms in liver transplant:Mitigating risk and managing infections.Liver Transpl.2016;22(8):1143-1153.
[21]Reddy P,Zembower TR,Ison MG,et al.Carbapenem-resistant Acinetobacter baumannii infections after organ transplantation.Transpl Infect Dis.2010;12(1):87-93.
[22]Sun HY,Cacciarelli TV,Singh N.Impact of pretransplant infections on clinical outcomes of liver transplant recipients.Liver Transpl.2010;16(2):222-228.
[23]Bellier C,Bert F,Durand F,et al.Risk factors for Enterobacteriaceae bacteremia after liver transplantation.Transpl Int.2008;21(8):755-763.
[24]Siniscalchi A,Aurini L,Benini B,et al.Ventilator associated pneumonia following liver transplantation:Etiology,risk factors and outcome.World J Transplant.2016;6(2):389-395.
[25]Lim S,Kim E J,Lee T B,et al.Predictors of postoperative infectious complications in liver transplant recipients:experience of 185 consecutive cases.Korean J Intern Med.2018 Feb 23.
[26]杨富,方芳,陈兰,等.肝移植术后多重耐药菌感染风险预测评分模型的建立与评价[J].护理研究,2017,31(17):2076-2080.
[27]Desai D,Desai N,Nightingale P,et al.Carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of infection after liver transplantation.Liver Transpl.2003,9(7):754-759.
[28]Hashimoto M,Sugawara Y,Tamura S,et al.Methicillin-resistant Staphylococcus aureus infection after living-donor liver transplantation in adults.Transpl Infect Dis.2008;10(2):110-116.
[29]Avkan-Oguz V,Ozkardesler S,Unek T,et al.Risk factors for early bacterial infections in liver transplantation.Transplant Proc.2013;45(3):993-997.
[30]谢秀华,姜英俊,解曼,等.肝移植后早期受者发生感染的危险因素及病原学分析[J].中华器官移植杂志,2017,38(4):200-205.
[31]Shi SH,Kong HS,Jia CK,et al.Risk factors for pneumonia caused by multidrug-resistant Gram-negative bacilli among liver recipients.Clin Transplant.2010;24(6):758-765.
[32]浦燕萍,顾燕,杨富,等.肝移植患者术后多重耐药鲍曼不动杆菌感染影响因素[J].中华肝脏外科手术学电子杂志,2016,5(3):158-162.
[33]Zhong L,Men TY,Li H,et al.Multidrug-resistant gram-negative bacterial infections after liver transplantation-spectrum and risk factors.J Infect.2012;64(3):299-310.
[34]Alonso JC.Pleural effusion in liver disease.Semin Respir Crit Care Med.2010;31(6):698-705.
[35]聂深钰,时宇,高普均.难治性肝性胸水的治疗[J].中国老年学杂志,2015,35(11):3171-3173.
[36]Machicao VI,Balakrishnan M,Fallon MB.Pulmonary complications in chronic liver disease.Hepatology.2014;59(4):1627-1637.
[37]Singh A,Bajwa A,Shujaat A.Evidence-based review of the management of hepatic hydrothorax.Respiration.2013;86(2):155-173.
[38]杨富.肝移植术后多重耐药菌感染风险预测模型的构建[D].上海:上海交通大学,2015.